Interview with Michael Paasche-Orlow, MD, MA, MPH, author of Caring for Patients With Limited Health Literacy: A 76-Year-Old Man With Multiple Medical Problems. Summary Points: 1. Massively increase patient education. 2. Systematically reduce unneeded complexity and variability. 3. Universal precautions (not screening), flip the default, and confirm comprehension (T2G).

Interview with Steven C. Zweig, MD, MSPH, author of The Physician's Role in Patients' Nursing Home Care. Summary Points: 1. Prevalent, fragile population, cared for until the end of life. 2. Care must be interdisciplinary (Facility, staff, physicians; Residents, family members). 3. Understand and anticipate natural history of aging and decline in long-term care, including planning, assessment, continuing care, acute care, and end-of-life care.

Interview with Daniel Leffler, MD, MS, author of Celiac Disease Diagnosis and Management: A 46-Year-Old Woman With Anemia. Summary points: 1. Celiac disease can present at any age with a wide variety of signs and symptoms and delay in diagnosis is common. 2. Testing for celiac disease with IgA tissue transglutaminase is accurate and cost-effective. 3. The only treatment for celiac disease is the gluten-free diet, but this is very burdensome and requires ongoing education and support.

Interview with Harold Sox, MD, author of New American Cancer Society Process for Creating Trustworthy Cancer Screening Guidelines. Summary Points: 1. Trustworthy guidelines require transparency about purpose, process, evidence, and rationale. 2. Trustworthy guidelines require a systematic review of the pertinent evidence. 3. Expertise in evaluating evidence and freedom from financial conflicts of interest are the main requirements for membership on a guidelines panel. If these are present, then clinical skills are important.

Interview with David S. Ludwig, MD, PhD, author of Weight Loss Strategies for Adolescents: A 14-Year-Old Struggling to Lose Weight. Summary Points: 1. Childhood obesity arises from a complex interplay of biology, behavior, and the environment.  Consequently, successful treatment requires targeting multiple determinants of body weight. 2. Family-based treatment offers the most immediate and effective approach for childhood obesity, with benefits for all family members. 3. Ultimately, the solution to the obesity epidemic will require a comprehensive public health strategy to make the social environment healthier for children and adults.

Interview with James T. Pacala, MD, MS, author of Hearing Deficits in the Older Patient: "I Didn't Notice Anything". Summary Points: 1. Age-related hearing loss is extremely common and underrecognized by most health care providers. 2. There are many effective methods of detection of hearing loss that are easy and efficient. 3. Although the main stay of treatment is amplification, there remain many challenges to effective hearing aid use.

Interview with Mary A. Whooley, MD, author of Diagnosis and Treatment of Depression in Adults With Comorbid Medical Conditions: A 52-Year-Old Man With Depression. Summary Points:

• Depression screening has no benefit unless it is combined with team-based management
• Self-management strategies (behavioral activation and exercise) improve depression
• "TEAMcare" can improve both depression and chronic medical conditions

Interview with Peter B. Bach, MD, MAPP, author of Benefits and Harms of CT Screening for Lung Cancer: A Systematic Review; and George T. O’Connor, MD, MS, author of Lung Cancer Screening, Radiation, Risks, Benefits, and Uncertainty. Summary Points:

• Three randomized trials examined computed tomography (CT) screening for lung cancer’s effect on lung cancer mortality—one showed a benefit, the other 2 did not but were smaller studies.
• CT screening does not appear to reduce mortality from causes other than lung cancer.
• There are still a lot of uncertainties regarding the risks and how to mitigate them.

Interview with Melanie A. Thompson, MD, and Paul A. Volberding, MD, authors of Antiretroviral Treatment of Adult HIV Infection 2012 Recommendations of the International Antiviral Society-USA Panel. Summary Points:

• Antiretroviral treatment is recommended and should be offered to all persons with HIV, regardless of CD4 cell count.
• Particular attention should be paid to the design of an antiretroviral regimen for persons with concurrent conditions, such as viral hepatitis, opportunistic infections, and other medical diseases, because of the potential for drug interactions.
• Monitoring of entry into and retention in HIV care, adherence to antiretroviral therapy, and quality of care indicators are recommended and should be used to increase care engagement and quality.

Interview with Philip Greenland, MD, author of Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate-Risk Individuals. Summary Points:

• In comparison with other competing biomarkers and risk factors, coronary artery calcium (CAC) is currently the most potent risk marker of subclinical coronary heart disease (CHD).
• CAC was shown in several observational studies to improve the prediction of risk beyond traditional risk factors.
• In this JAMA paper, CAC outperformed various competing risk assessment markers among asymptomatic people at intermediate risk for CHD. Whether CAC should be used in routine clinical practice, however, is still a matter of personal opinion or further research.

Interview with Robert W. Haley, MD, author of Controlling Urban Epidemics of West Nile Virus Infection. Summary Points:

• Epidemics of West Nile neuroinvasive disease have become a serious medical and public health challenge that will be with us for the foreseeable future.
• Ultra low-volume aerial spraying of urban areas, guided by surveillance of mosquito trap positivity and human cases, is necessary and cost-effective to prevent chronic neurologic disability and death.
• Complete, accurate, and timely diagnosis of West Nile viral disease in an epidemic is vitally important to spare patients needless prolonged antimicrobial therapy and build support for public health control measures.

Interview with Nancy A. Rigotti, MD, author of Strategies to Help a Smoker Who Is Struggling to Quit. Summary Points:

• Treat tobacco use like the chronic disease that it is. Don't give up if your first few efforts do not succeed.
• Medications and brief counseling are each effective, but combining the two is most effective.
• Link your smokers to free national resources like the tobacco quit lines (1-800-QUIT-NOW). New noncombustible tobacco products are coming.

Interview with Laura N. Gitlin, PhD, author of Nonpharmacologic Management of Behavioral Symptoms in Dementia. Summary Points:

• Attending to behavioral symptoms is part of comprehensive dementia care and requires ongoing long-term management.
• Use 6 steps to systematically prevent, assess, manage, eliminate or reduce behavioral symptoms.
• Use combination of nonpharmacologic approaches.
• Keep trying—nonpharmacologic approaches are relatively adverse free.
• Create a health professional team to offset time needed for provision of nonpharmacologic approaches.

Interview with Robert H. Shmerling, MD, author of Management of Gout: A 57-Year-Old Man With a History of Podagra, Hyperuricemia, and Mild Renal Insufficiency. Summary Points:

• Risk factor modification: alcohol intake, excess weight, diet, medications (although overall impact on gout uncertain).
• Acute gout can be treated with NSAIDs, colchicine, corticosteroids, or a combination of these.
• Urate-lowering treatment to prevent attacks and tophi is appropriate for certain patients with gout. (In my opinion, allopurinol is the best initial choice to suppress uric acid.)
• Urate-lowering treatment should suppress uric acid to 6.0 mg/dL or less; allopurinol should start no higher than 100 mg/d but titrate up based on uric acid levels; it is common to require more than 300 mg/d.
• Concomitant prophylaxis (eg, low-dose colchicine, 0.6 mg/d) is appropriate for 6-9 months or longer.

Take home message:
We now have new therapies and guidelines for the treatment of gout. Appropriate use of therapeutics for gout—both new and old—will provide optimal outcomes for the increasing number of patients with this common disease.

Interview with Daniel J. Buysse, MD, author of Insomnia. Summary Points:

• Insomnia is a frequent comorbid condition that increases costs and worsens outcomes.
• Insomnia is a chronic condition for which there are effective and widely available acute treatments (medications) and effective but hard-to-find long-term treatments (behavioral).
• Need to consider other health professionals such as nurses, physician assistants, and behavioral health managers (smoking, obesity, diet, exercise, sleep/insomnia).

Interview with Phillip M. Boiselle, MD, author of Computed Tomography Screening for Lung Cancer. Summary Points:

• CT screening reduced lung cancer-specific mortality by 20% in a large randomized trial of a high-risk population.
• CT is associated with a high false-positive rate, with associated risks and costs associated with follow-up CT and the potential for more invasive diagnostic procedures.
• Physicians should consider discussing CT screening with their high-risk patients who meet criteria in published guidelines.

This Viewpoint attributes improved understanding of the role of autoantibodies and B-cell activity in MS pathogenesis and the development of effective therapies to the ability of physician-scientists to bring clinical insights to laboratory research and it emphasizes the importance of supporting and encouraging these investigators to reinvigorate science at the bedside.

This Viewpoint proposes a framework for international cooperation among governments and organizations to replace competition and hoarding with equitable global distribution of COVID-19 therapeutics and vaccines as they are developed.

This Viewpoint proposes that universal respiratory precautions in the operating room—use of respirators with face masks and eye protection—could protect staff from possible coronavirus disease 2019 (COVID-19) infection and facilitate resumption of elective surgeries canceled during the first wave of the pandemic.

This population epidemiology study characterizes trends in polymerase chain reaction (PCR) test positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Washington State and the Seattle area between March 1 and April 16, 2020, before and after statewide physical distancing guidelines and stay-at-home orders.

This Viewpoint discusses considerations that might lead physicians to change their practice based on RCTs reporting non–statistically significant differences in primary outcomes, including trial methodology, totality of evidence, cost, invasiveness, and labor-intensiveness of the interventions being compared.

My first glimpse into the craft of physician-writers did not come through Anton Chekhov, Walker Percy, or William Carlos Williams, whose works I only came to after medical school. As a schoolboy, I loved W. Somerset Maugham, although he never practiced medicine, and his craft had little to do with his medical degree. My introduction to physicians as writers came through my textbooks. Boyd’s Pathology made me aware of literary voice, the ability of authors to place themselves in the text, let their personality come through, and subtly become a character in the reading experience. On the topic of defining the moment of death, Boyd in his single-author text wrote, “It was the author of the book of Ecclesiastes who said, ‘There is a time to be born, and a time to die.’ Fortunately it is the clinician, not the pathologist, who has to make this difficult decision. Sometimes, however, the kindly doctor may find himself murmuring those moving lines from the last act of King Lear: O let him pass! He hates him/That would upon the rack of this tough world/Stretch him out longer.”

Forty years ago, in 1980, Jimmy Carter was president. Pac-Man debuted. In medicine, smallpox was declared to be eradicated. Additionally, on May 9, 1980, A Piece of My Mind was inaugurated in JAMA. The first essay, “Tuna on Rye, 1984,” was written by then–senior editor Samuel Vaisrub under the pen name Sam Vee. He introduced the column with an editorial entitled “For the Peace of Your Mind.”

Listen to the JAMA Editor’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA.

We hasten to assure our readers that a piece of my mind...is not intended as a sounding board for peevish gripes, nit-picking beefs, or sundry assortments of righteous indignation, which are usually prefaced by an angry “let me give you a piece of my mind.” Nor is this section of The Journal meant to be a podium for pompous preachments and ex cathedra pronouncements. Nor again is it designed to be a forum for half-baked speculations and warmed-over hypotheses. Least of all is a piece of my mind envisaged as a jamboree of jokes and a shivaree of limericks.

As my Italian father would say, since the house is burning      let us warm ourselves, and so

In this narrative medicine essay, a primary care physician describes his patient’s struggle with obesity, sees himself in his patient, and wonders if his own struggles with weight loss impede his patient’s efforts to lose weight.

In this narrative medicine essay, a psychologist peels back the layers of her reticence and comes to terms with working with transgender patients as a member of LGBT community.

In this narrative medicine essay, a primary care physician describes a drawing by a 7-year-old patient who is sitting on an examination table with her mother cradling her baby sister with the physician’s back to them entering data in the computer as an example of a system that is sacrificing human contact for electronics.

In this narrative medicine essay, Donald M. Berwick shares the story of his patient Isaiah with the 2012 Harvard Medical School graduating class as an example of a patient who deserved the treatment that cured him of leukemia but whose life was lost to poverty and exhorts them to regard health care as human right that must be preserved in the clinic and in public.

In this narrative medicine essay, an attending physician shares his observations of how the changing nature of electronic medical record (EMR) hospital progress notes—often entered out of sequence and becoming ever longer and more unreadable—can hamper interacting with patients and providing patient care.

In this narrative medicine essay, a group of physicians from an academic program in bedside medicine offer their observations on deficiencies in the assessment of US medical residents’ clinical skills and suggest principles for enhancing the teaching and high-stakes assessment of these skills to improve diagnostic accuracy and achieve truly patient-centered care.

In this narrative medicine essay, a physician reflects on the rise of professional boundaries; on the ways in which such boundaries can in some instances foster uncaring patient-physician relationships; and on ways physicians might balance providing objective medical care and addressing social and economic injustices in the lives of their patients.

In this narrative medicine essay, a physician shares his thoughts about how the phrase “there is no evidence to suggest,” commonly used in the medical literature, can lead to false inferences and suppression of clinical intuition, and suggests four alternative phrases for clarifying inferences and improving shared decision-making.

In this narrative medicine essay, an emergency medicine physician recalls an encounter early in her career when she was asked by parents to make a recommendation regarding ending life support for a young child, reflects on the way practice has changed from physician-centric to patient-involved decision-making, and discusses how her husband’s pancreatic cancer diagnosis brought up a different perspective.

In this narrative medicine essay, an African American physician reflects on her experience one day with a white member of her ward team made up of two interns, three medical students, and a senior resident that sparked cultural and racial discussions throughout their month together that usually do not occur in such a diverse group.

In this narrative medicine essay, an attending physician reflects on the evolution of the role of the attending physician from a supervisor in the background to a micromanaging supervisor to ensure that the proper steps are followed to meet the quality metrics in place in the current health system.

In this narrative medicine essay, a physician describes the power of anecdotes and stories as tools for public communication, education, and advocacy.

In this narrative medicine essay, an anesthesia resident describes his feelings of loss and unease when a coresident is admitted as a patient and dies of an overdose of fentanyl; this article emphasizes the importance of prioritizing physician wellness programs to help avoid burnout and substance use disorder.

In this essay, Don Berwick considers moral choices physicians face personally, organizationally, and globally and exhorts them to understand that the health of humanity depends on their speaking out against the social injustice of overpricing drugs and services, mass incarceration, and the lack of environmental responsibility.

In this essay, a critical care pediatric hospitalist finds herself on the other side of the office table advocating for the specific medical care needed to address her son’s rare skeletal dysplasia and her search for a pediatric specialist with whom to travel on this quest.

In this essay, a young medical student describes her struggle with depression and how the experience of vulnerability has bred a deep compassion for her patients and peers.

In this narrative medical essay, an internist offers three basic lessons not taught in medical school that he learned about practicing medicine based on his experiences from a patient with whom he has built a trusting relationship over the years.

In this narrative medicine essay, the author mourns the suicide of young adult of a friend and relives his brother’s suicide 30 years earlier in a stream of consciousness montage of grief and advice to succor for those left behind.

In this narrative medicine essay, a family practitioner tells the story of how her relationship with an old-order Mennonite woman whose newborn son she examined and took to the hospital for cardiac surgery one Christmas day turns to friendship and a relationship with her broader community when the woman stays with her during her newborn daughter’s cardiac surgery.

In this narrative medicine essay, a psychiatrist used her residency to avoid grieving the loss of her brother to suicide but through participation in a grief support group during training she began to thaw enough to remember her brother, watch videos of ephemeral moments like celebrating his fourth birthday, an act that allowed her to see him and her family again.

In this narrative medicine essay, a physician finds in the motion of diastole, the process of letting go and filling up, an apt metaphor for how to handle the burnout, anxiety, and depression of medical training.

In this narrative medicine essay, a medical school dean talks about the reticence most women feel when considering leadership roles and urges women to work out of their comfort zones, seize diverse opportunities, and step into leadership roles.

In this narrative medicine essay, a surgeon and palliative care physician describes the isolating silence that she felt her after the slaying of her father in Egypt when she was 18 years old and how that lingering silence has come to guide her when sitting with patients, when there are no words.

In this narrative medicine essay, a clinical educator uses her experiences enduring the aftermath of treatment for acute myeloid leukemia to reflect on the difference between physician-teachers and patients’ experience of illness and to locate meaning in what she can offer her colleagues and trainees despite persistent disability.